How can Industrial Back Injuries occur?
In California, Workers’ Compensation Back Injuries can occur in many ways. Injuries can be the result of a specific incident, a cumulative trauma, a presumptive injury, or a compensable consequence arising out of an injury to other body parts or systems. A Back Injury can also be an aggravation of a pre-existing back condition. This article discusses the types of industrial back injuries, the testings that are available, an the treatments that are available.
A specific injury is the most basic of workers’ compensation injuries. Specific Injuries commonly occur as a result of physical activities such as a lifting incident, from a car accident, or from a trip and fall.
A cumulative trauma (CT) injury is one that occurs over time. CT Back Injuries can be caused by repetitive or prolonged physical activities. Examples of cumulative trauma mechanisms of injury are repetitive lifting or prolonged sitting.
California Workers’ Compensation Law provides for a legal presumption for Back Injuries for certain Law Enforcement Personnel. Labor Code Section 3213.2 provides a special presumption concerning back injuries for certain Law Enforcement Personnel who wear duty belts as a condition of their employment.
A compensable consequence is an injury that arises out of an initial industrial injury. For example, a person who injured a knee may walk with an altered gait or limp. The limping can aggravate the person’s pre-existing back problem. This aggravation is to be considered as an industrial injury. Another example of a compensable consequence can be an injury sustained which seeking industrial medical treatment. For example, an injured worker with a shoulder problem gets into a car accident and injures their back. This would be considered a compensable consequence.
Aggravation of a Pre-Existing Back Condition
An aggravation of a pre-existing back condition is also a workers’ compensation injury. Aggravations can fall into the categories of specific, cumulative trauma, or compensable consequence.
What are the types of Back Injuries that can occur as a result of an Industrial Accident?
Sprains & Strains
A sprain or a strain is a lumbar injury in which there is the swelling of local tissues when ligaments, muscles, tendons, or combinations become traumatized by being overstretched, overused, or torn. The swelling can cause pain, tenderness, and stiffness.
Disks, located in the spine, can rupture and herniate and tear through their exterior. Herniated disks can irritate nerves, cause pain, cause numbness or weakness in the leg. Herniated disks can also cause problems with urination and bowel movements.
Spine fractures can range from painful compression fractures, often seen after minor trauma in osteoporotic patients, to more severe injuries such as burst fractures and fracture dislocations that occur following auto accidents or falls from height. These severe injuries frequently result in spinal instability.
What Diagnostic Tests can be done on Back Injuries?
California Workers’ Compensation law provides for medical treatments which may include diagnostic testing. Initially, an evaluation by a skilled physician is indicated. If the evaluation suggests certain medical conditions, a skilled physician will request for diagnostic tests to either confirm or rule out their possibility. Diagnostic studies are important to determine the course of treatment indicated.
Common diagnostic tests which are done to diagnose lumbar spine conditions are as follows: X-Rays, Computed Tomography(CT), Magnetic Resonance Imaging Studies (MRI), and Nerve Studies (EMG/NCV.)
California Workers’ Compensation law limits testing. A doctor must order the tests via a “Request for Authorization” (RFA). RFAs are subject to approval from the insurance companies via Utilization Review (UR.)
X-Rays view the bone. In the spine, the vertebrae can be viewed. X-Rays can show whether there are any fractures. Flexion and extension x-rays can show if there is abnormal movement. X-Rays can show whether the spine is degenerating.
Computed Tomography Scans
CT is a noninvasive test that creates 2 dimensional images of the spine. It can be done with contrast via the use of dye injected into the body. Contrast improves the viewing of the image.
Magnetic Resonance Imaging
MRI is a noninvasive test that gives a view of the soft tissues in the spine. The MRI allows for the ligaments, discs, and nerves to be viewed. MRIs can be done with contrast that can improve the image viewing. Contrast is used when there is scar tissue that can impact on the quality of the view.
Nerve Conduction Study (NCS)/Electronmyography(NCV/EMG)
A nerve conduction study measures can determine nerve damage and/or destruction. An EMG measures the electrical activity in muscles and is often performed at the same time as NCS. Both procedures help to detect the presence, location, and extent of diseases that damage the nerves and muscles.
What are treatments for Back Injuries?
In California Workers’ Compensation Law, treatment is subject to Utilization Review. Initially, doctors will submit “Requests for Authorization (RFA)” for the recommended treatment. Prescriptions on a prescription pad are not sufficient. Further, these RFAs will be subject to utilization review by the carrier. Generally, treatment must also follow an algorithm. This means that certain tests or treatments must be done before more invasive ones are done. For example, a course of physical therapy may be required to be completed before a surgery will be authorized.
The following are examples of treatments for back injuries:
- Heating Pads
- Non Steroidal Anti Inflammatory Drugs (NSAIDs)
- Muscle Relaxers
- Narcotic Pain Medication
- Controlled Exercise/Physical Therapy
- Chiropractic Care
- Back Braces
- Trigger Point Injections
- Epidural Steroid Injections
The following are examples of surgical treatments for an injured back:
In the lumbar spine, the decompression surgery involves the opening or removing of bone to relieve the pressure and/or pinching the nerves in the lumbar spine. A discectomy is a surgery in which herniated disk material is removed to decompress the nerve root.
A minimally invasive surgery for treatment a lumbar herniated disk that is causing radicular leg pain (sciatica).
A laminectomy removes part of the layer of the bone or soft tissue that is compressing a nerve or multiple nerve roots. A laminectomy will typically be performed for someone with leg pain and/or weakness from spinal stenosis caused by changes in the facet joints, disks, or bone spurs.
A fusion surgery basically removes the soft tissues between two or more adjacent vertebral bones and replaces them with bone or metal. This procedure enables the bones to grow together over time—typically 6 to 12 months—and fuse into one long bone to stabilize and eliminate motion at those spinal segments.
Lumbar Artificial Disk
A disk replacement is an alternative to fusion surgery for symptomatic degenerative disc disease. It is a relatively new treatment and is considered experimental. Authorization for such a procedure in workers’ compensation may be difficult.
Chronic Back Pain treatment is also available to treat workers’ compensation back injuries. Chronic Back pain treatments include implantable pain management systems such as:
- Spinal Cord Stimulation
- Peripheral Nerve Stimulation
- Pain Pumps
The Law Offices of Edward J. Singer
With more than 23 years of expertise in defending workers’ rights, the Law Offices of Edward J. Singer, A Professional Law Corporation, is here to assist. If you have any questions concerning your rights, please do not hesitate to contact our offices. Please contact us today concerning any workers’ compensation questions or issues.